Thursday, February 15, 2007

Every once in a while you get one: a week in which every second patient, it seems, has something nobody can pronounce. Or, at least, can't pronounce without practice and enough tries that some endocrinologist somewhere starts to snicker.

We don't have an emergency room. If a patient returns to us for some reason, they're usually triaged downstairs in the triage department, but sometimes they end up on one floor or another. (Keep in mind here that I'm not talking about people who, say, show up with one arm in a garbage bag or with a huge gaping hole where their head used to be.) We had somebody like that this week: she was in diabetic ketoacidosis, something I not only hadn't seen since nursing school, but stumbled over trying to pronounce.

And, since we're a research facility, we often get other hospitals' GOKs. GOK stands for God Only Knows, the sort of thing that's most often diagnosed on autopsy. In the past ten days, I've had a patient with olivopontine cerebellar ataxia (say that five times fast), one with gliomatosis cerebri (also known as infiltrative diffuse astrocytosis), and one poor schmuck who showed up with neurocysticercosis (worms in your brain). Oh, and the one with afibrinoginemia. (You don't clot. Dude.)

When people with unpronounceable diagnoses start showing up in droves, there's a corresponding rise in bizarre lab tests. Neurologists are particularly bad about ordering blood tests that can only be done with a reagent made from the fangs of Tibetan fruit bats. When the lab calls me with the news that the leptospiritus-santusomphalowaggle-L53 test can only be done during the dark of the moon on Thursdays, the conversation rapidly devolves into something like this:

Lab: "The doc ordered a 4,5-endopthalamucoid whingzap study on this patient's CSF. The 4,5-E-W test is obsolete. It's been replaced with the trigemisalamisofgame test with the Elisa ketohamonryenomustard confirmation, but we can only draw that on alternate Saturdays during April."

Me: "But my patient has leptocryptosanguinofibrinogingliomaturia! And a midline shift! I've got to get this lab done! Can I draw it myself?"

Lab: "Yeah, sure. Just be sure that you use a 20-gauge needle and move diagonally, and only on the black squares. Oh, and don't get your patient wet after you draw it, and for God's sake, *don't* feed him after midnight."

I've developed a persistent twitch under my right eye. The internal medicine residents assure me that it's common, nothing to be concerned about, and should go away as soon as I stop my exposure to unpronounceable words.

4 comments:

I just diagnosed a guy the other day with leptocryptosanguinofibrinogingliomatemia. Apparently the levels hadn't yet risen high enough to be excreted in the urine. At least I was able to catch the endocrinologist and the neurologist at the same time (they were performing a pagan sexual ritual) since, as you know, the treatment is a staged procedure by each of them in turn.

I've been learning all about tests performed at the dark of the moon while the patient balances on one leg and the technician sings the verses of the Baghavad Ghita. Fortunately, as it turns out I don't have anything unpronounceable - just three relatively common things interacting with each other in weird and wonderful ways.